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Conclusions: A departmental consensus list of common clinical presentations and their respective differential diagnoses was compiled.
Take-home messages: This study represents the first step towards developing an undergraduate clinical presentation-oriented Internal Medicine curriculum that is tailor-made for South Africa's health milieu.
Critical analysis of the Endocrine and Diabetes Module of the Core Medical Training curriculum
Umesh Dashora (East Sussex Healthcare Trust, Diabetes and Endocrinology, St Leonards-on-Sea, United Kingdom)
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(Presenter: Christopher Ashton, East Sussex Healthcare Trust, Rotation, Conquest Hospital, Little Ridge Avenue, St Leonards-On-Sea TN37 7RD, United Kingdom)
Background: The General Medical Council has defined the curriculum as a, 'Statement of the intended aims and objectives, content, experiences, outcome and processes of a programme, including a description of the structure and expected methods of learning, teaching, feedback and supervision.'
Summary of work: We analysed the existing Endocrine and Diabetes module of the core medical training to see whether it satisfies the stated requirements of a curriculum.
Summary of results: We found that the module had the desired elements of learner centred approach delivered through e portfolio, competency based well-laid out syllabus, link to suggested tools for assessments, but some aspects remain unachieved like plans for adequate staffing, promotion of reflective and autonomous thinking, tools for learning form practice, clinic letters, audit projects and critical incident review. Specific to diabetes, in-patient diabetes care, community diabetes and leadership training in diabetes service organisation were not adequately represented in the curriculum. Professionalism and virtuous practice of medicine were not explicitly mentioned in the curriculum and no suggestions were mentioned as to how to assess them. Use of online resources was not detailed. We recommend revising the existing curricula to include these elements.
Conclusions: We recommend revising the current curriculum to include the elements unachieved in the results and to integrate a partnership approach between teachers and learners.
Take-home messages: The existing curriculum does satisfy the stated requirements of a curriculum however to maximise the teaching of the trainees certain aspects can be improved and we have made some recommendations.
Characterizing a Portuguese medical school hidden curriculum
Leonor Carneiro Leao (Centro Hospitalar da Cova da Beira, Medicine, Praca da Missilva, 20, 2°drt, Porto
Joaquim Silva Viana (Faculdade de Ciencias da Saude -Universidade da Beira Interior, Medicine, Covilha, Portugal)
Luis Manuel Taborda Barata (Faculdade de Ciencias da Saude - Universidade da Beira Interior, Medicine, Covilha, Portugal)
Background: Patient-centered care is a fundamental clinical method contributing towards the quality of healthcare. However, studies have shown a decline in patient-centered behaviours/attitudes in medical students. The influence of a hidden curriculum may underlie these results. The C3 Instrument (questionnaire to characterize the patient-centeredness of a medical
school hidden curriculum), was previously developed and validated in English and then adapted to the Portuguese language.
Summary of work: This study aimed to characterize the patient-centeredness of the hidden curriculum in the Faculty of Health Science - University of Beira Interior (FCS-UBI) (Covilha-Portugal) using the C3 Instrument. It was applied to medical students from the last 2 years. Responses were analysed by applying descriptive and inferential tests.
Summary of results: The C3 Instrument was completed by 145 students, with a response rate of 94%. The FCS-UBI students' C3 results were similar to the ones found in USA medical schools.
Conclusions: FCS-UBI medical students seem to be exposed to a similar hidden curriculum as the ones found in USA medical schools. A more detailed analysis highlighted some points where intervention might modify or decrease the negative impact of the hidden curriculum upon human and professional development of medical students.
Take-home messages: The hidden curriculum might be the most powerful force shaping medical students attitudes and behaviours. Knowing the hidden curriculum of a medical school is crucial towards its development. Interventions might be needed to modify/decrease the negative impact of the hidden curriculum upon human and professional development of FCS-UBI medical students.
Stakeholders' perspectives about Institutional culture and curriculum reform a decade after the Brazilian Curricular Guidelines for the undergraduate medical course
Edna Regina Pereira (Edna Regina Pereira, Universidade Federal de Goias, Clinica Medica, RUA SB 33 QD 49 LT 14. Portal do Sol 2, Rua C-149 N° 1145, Goiania 74884643, Brazil)
Suely Grosseman (Universidade Federal de Santa Catarina, Pediatria, Florianopolis, Brazil) Eliana Amaral (Universidade Estadual de Campinas, Ginecologia e Obstetricia, Campinas)
Background: The Brazilian Guidelines were published in 2001. The goal was to stimulate adjustment of the curriculum more adequately to prepare competent and reflective doctors, able to answer to the health needs of the society, strengthening the Brazilian Unified Health System.
Summary of work: An exploratory qualitative research was done to know the advances made and the challenges faced by the medical schools during curriculum change. We performed by phone semi-structured interviews with one student, one professor and the Dean of eighteen public and private medical schools randomly selected. Thematic content analysis was used. The study was approved by the Ethics Board
(Brazil Platform, CAAE:01376712.7.0000.5404).
Summary of results: Changes occurred in all the schools. However, the changes' amplitude varied according to
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the institution's culture, leadership, and adhesion to funding support through governmental project. We identified three school cultures: traditional, adaptable and highly adaptable. The participants of traditional schools reported few changes and high faculty resistance. Those from adaptable schools reported that the process of change was easier. The participants of highly adaptable schools mentioned that the changes began even before 2001 and highlighted a "strong" leadership, and that the stakeholders like to try new methods and are not afraid of changes. Conclusions: The resistance of traditional schools' stakeholders may be caused by their difficulty in handling the unpredictability and uncertainty inherent to changes. It is easy to change the curriculum in adaptable schools. Perhaps, the investment in building an adaptive culture in the traditional institutions could facilitate the changes.
Take-home messages: Building an adaptive culture in the school can be a key to make changes happen.
Professional growth and nursing education at
Giancarlo Cappello (ISMETT (Istituto Mediterraneo Trapianti e Terapie ad alta Specializzazione), Nursing Education, Via Giorgio La Pira, 19, Belmonte Mezzagno (PA) 90031, Italy)
Filippo Marchese (ISMETT (Istituto Mediterraneo Trapianti e Terapie ad alta Specializzazione), Nursing Education, Palermo, Italy)
Background: Since 2004 ISMETT's nursing education group has had a training program for newly hired nurses. ISMETT (The Mediterranean Institute for Transplantation and Advanced Specialized Therapies), founded in 1998, is an 80-bed hospital in Palermo, Italy. Summary of work: The nursing education group consists of six nurse educators, each assigned to a specific operational unit. Our training schedule includes four weeks of theoretical training and six courses on emergency clinical simulation, punctuated by observation within the operating units, and followed by a one-month period of mentoring with a nurse preceptor. The main contents of training include the electronic medical record, lectures on ECG, hemodynamics, infection control, medication, unit-specific procedures, and basic and advanced management of emergencies.
Summary of results: From 2004 to 2012, we trained 369 nurses, and assessed the results from both a theoretical and practical standpoint, using multiple-choice tests, practical debriefing in a simulation environment, and skill evaluation checklists.
Conclusions: At present we have a form of structured training, with attention to content and training objectives, and punctuated by constant assessments in the course of learning, designed to optimize timing and results of educational intervention. The achievement of skills is encouraged by an annual assessment that assigns to the nurses a different skill level (basic-
intermediate-advanced), closely related to the professional growth of each nurse. Take-home messages: Professional growth related to nursing education must always be based on the rigor of well-structured training and, at the same time, openness to technological innovations and new training needs.
A comparison of the performance of students from life sciences vs medicine and its allied specialties in an objective test on regenerative medicine: the lessons learnt for curriculum development
Pushkala Subramanian (The Tamilnadu Dr MGR Medical University, Examinations, 69, Anna salai, Guindy, Chennai 600032, India)
Background: Regenerative Medicine (RM) is a growing paradigm in biology in which the constant interaction and communication between basic scientists and clinicians is indispensable. In this study we have analysed the performance of students studying undergraduate and post-graduate courses in the fields of medical and its allied specialties. Summary of work: We have analysed the performance in terms of scores in an objective multiple choice quiz of students studying graduate and post-graduate courses in the above mentioned fields in a quiz on stem cells and
Summary of results: The results revealed that the average scores of students studying medicine and its allied specialties were high compared to students studying life science courses. A two sample t-test revealed statistical significance in the scores (P value = 0.04; P <0.05) between students of these two categories. Students from medicine and its allied specialties won the quiz three times and even students studying the exclusive RM course won the quiz twice. Students from the field of life sciences did not win the quiz even once.
Conclusions: Exposure and information gained on concepts in Regenerative Medicine is less among students studying life science courses in higher education compared to students studying courses in medicine and other allied specialties. Take-home messages: This upcoming field of medicine should be included in the curriculum of the science students too.
The influence of preceptor power style on learner empowerment: a measure of the hidden curriculum in clinical learning environments
Judy Baird (McMaster University, Family Medicine, Hamilton, Canada)
Keyna Bracken (McMaster University, Family Medicine, Hamilton, Canada)
Lawrence Grierson (McMaster University, Family Medicine, Hamilton, Canada)
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Background: Clinical learning occurs in environments wherein students may compromise their values in order to be perceived positively by supervisors. Preceptor influence represents a type of social power, an important determinant of an individual's sense of personal empowerment in any environment. Summary of work: Early (n = 77) and late (n =79) stage clerks from six disciplines completed modified Teacher Power Use (TPUS) and Learner Empowerment (LEM) scales for their primary preceptor- identified simply as either staff physician or resident- and their personal senses of empowerment, respectively. TPUS and LEM outcomes were subjected to correlational analyses as well as independent 2 cohort by 2 preceptor by 6 discipline analyses of variance. Summary of results: Learner perception of empowerment was correlated positively (r = .66, p < .05) with pro-social preceptor power use and negatively (r = -.32, p < .05) with coercive power use. Furthermore, coercive power use was perceived more strongly by students with a resident as the primary supervisor (F (4, 572) = 4.7, p < .05).
Conclusions: Preceptor power use impacts learners' sense of empowerment in clinical learning environments. Rotations where residents provide the majority of clerk supervision are more likely to subject learners to coercive power environments, which may in turn contribute negatively to their socialization into the profession.
Take-home messages: This study highlights the relationship between power use and perception of empowerment and uses the hidden curriculum framework to discuss the way cultural and/or organizational influences can potentially impact learners' values and professional behaviour.
Conceptions of teachers from a medical school of a Federal University in Brazil about the relationship between medical work, medical education and social demands
Francisco Jose Passos Soares (Federal University of
Alagoas, Faculty of Medicine, Av. Eraldo Lins Cavalcante,
698, Murilopolis, Maceio 57045-430, Brazil)
Marilia Bulhoes Calheiros (Federal University of Alagoas,
Faculty of Medicine, Maceio, Brazil)
Mariana Percia Name de Souza Franco (Federal
University of Alagoas, Faculty of Medicine, Maceio,
Background: The curriculum guidelines for Brazilian medical courses provided changes that guide for the training of generalist doctors with a critical and humanist profile. Although curricular change in medical school of the Federal University of Alagoas started in 2006, we still can observe dissatisfaction from teachers with a curriculum oriented towards training of generalists doctors with emphasis on primary and secondary levels of health care. Summary of work: This paper aims to observe how medical teachers from the Federal University of Alagoas
perceive and articulate concepts related to medical work, medical education and social demands. This is a qualitative study of content analysis from responses stimulated by standardized questions, which were recorded and later transcribed. We interviewed 23 teachers in a sample of convenience, to the point of saturation.
Summary of results: 100% of teachers responded that medical work does not meet current social demands, pointing out deficiencies found in primary care. 50% said that medical education is oriented towards current requirements for medical work, emphasizing the curriculum's goal to train generalists focused on the need of the population, despite the fact that the market leads doctors for speciality. The remaining 50% responded negatively to the same question, saying that there is still a gap between theory and practice and that medical education should not only be focused on primary care.
Conclusions: Teachers consider that medical work is undervalued and in disagreement with social demands; also they consider that the job market competes and supersedes the current medical education oriented towards primary and secondary care.
Societal commitment, competitiveness and public health system: views and perceptions of the Chilean medical students and graduates
Gisela Alarcon (School of Medicine, University of Chile, Independencia 1027, Santiago 8380000, Chile) Francisca Decebal-Cuza (School of Medicine, University of Chile, Santiago, Chile)
Victor Acuna (Consultant School of Medicine, University
of Chile, Santiago, Chile)
Paz Barrientos (Consultant School of Medicine,
University of Chile, Santiago, Chile)
Cecilia Sepulveda (Faculty of Medicine, University of
Chile, Santiago, Chile)
Background: 180 years since its foundation, during 2013 the School of Medicine of University of Chile, pursuing social accountability with academic excellence, is changing its curriculum and is selecting and supporting socially disadvantaged medical students. This qualitative study investigated medical interns' and graduates' self-image, societal commitment and personal aspirations concerning their professional development, as a baseline providing inputs for these meaningful changes. Summary of work: During 2012 medical interns and five year graduates participated in a qualitative study using "grounded theory" method, through 18 in-depth interviews and 2 focus groups. The first part of this study was done with first and fourth year medical students during 2011.
Summary of results: In spite of the ideals for social commitment that drive the preference for our Medical School, students and graduates feel a loss of social engagement in their medical practice. Related to the desire to become specialists instead of general practitioners, with individual gain over social impact,
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they strengthen competitiveness as driving their behavior. On their view, this is also a result of the conditions of the public health system in Chile. Conclusions: Competitiveness during the career and the lack of strong public policies encouraging social commitment of medical doctors are seen as obstacles to fulfilling social accountability, with the loss of social engagement in the medical practice. Take-home messages: The School of Medicine has a challenge for the new curriculum but also has to strengthen partnership with stakeholders (public policy makers) as a socially accountable medical school.
Aligning Medical Education with the Needs of Health Challenges
Nancy Margarita Rehatta (Faculty of Medicine, Medical Education, Mayjen, Prof Dr Moestopo no 6-8, Surabaya 60131, Indonesia)
Fundhy Prihatanto (Faculty of Medicine, Medical Education, Surabaya, Indonesia)
Background: Based on national demand, the goal of Indonesian Medical Education is to produce primary health care physicians. Competencies requirements that should be achieved by the graduates are decided respecting the community healthcare needs. Considering factual problems and the health challenges, in the year 2005 the curriculum committee appreciated the need of updating the curriculum with additional content concerning emerging and re-emerging disease and mass disaster, as primary care physicians will play a role as healthcare providers and leaders of healthcare teams in meeting these potential healthcare challenges. Summary of work: A learning strategy was arranged to facilitate the students obtaining a theoretical base and professional skills. In the early semester the theoretical base is discussed through interactive lectures facilitated by experts of medical science, communication and leadership, followed by problem based small group discussion, doing a community survey to face the actual problems or field training in a mass disaster block. In the clinical stage they stay one month in the primary healthcare center to practice medical care, leadership and teamwork.
Summary of results: There are increasing numbers of student research projects that relate to emerging and re-emerging disease, and likewise the number of students that joined the social program for special health population or enrolled as volunteers in a medical team for disaster.
Conclusions: Medical education should be designed to meet health needs. As predicted, currently re-emerging disease and natural disaster become a prominent health problem.
Take-home messages: Regularly updating the curriculum is necessary to make medical education responsive and relevant to the health system.
Philosophy, science and quality of planning Applied Medical Curriculum
Eisa Johali (King Saud University, College of Applied Medical Sciences, Community Health Sciences, P. O. Box 10219, Riyadh 11433, Saudi Arabia)
Background: Despite hard work, leaders insist on making their own bureaucratic decision without philosophical and scientific bases. Meanwhile, there was a huge debate between health care and education leaders on how to assure quality and theory-practice balance.
Summary of work: This work focused on investigation of the relationship between quality and the most common philosophies and theories that were applied or appropriate to be applied for nursing and applied medical education in United Kingdom, United States and Saudi Arabia. It used a creative integrated research model derived from the historical educational development research with documentary analysis. Summary of results: This study begins by deliberating on the problems of the Saudi Arabian Nursing and Applied Medical Education and Practice, mainly the debate between the Saudi nursing education and nursing service regarding the quality of the graduate nurse students and the dilemma of the gap between theory and practice. Reflection on experience throughout studying the MA (Ed) courses and theses suggested that "the Western philosophy and science of curriculum, teaching and learning may guide Saudi Arabia towards a factual way to overcome these considerable problems and to assure quality as well". After its investigation, compassion, the study focused on 25 philosophical and scientific worldwide used models. Conclusions: After using 'the related Islamic Ethical bases with Poppers' notions of conjectures and refutations', to validate its results, the study endeavours to modify Michigan's philosophy into a philosophy of fourteen theories as a base for future developmental studies.
Take-home messages: To assure total quality of health, health care services and planning and development of nationally applied medical education and curriculum, we have to conduct more philosophical and scientific based research, starting by preparing the ground for quality, philosophy and scientific theories based teaching, learning and curriculum planning and development.
5th-year Medical Student Knowledge of Patient Safety
Chat Sumananont (Khon Kaen University, Faculty of Medicine, 123 Mitraparb rd, Tumbon Ni-Muang Ampur Muang, Khon Kaen 40002, Thailand)
Background: Background: Patient safety is the one of the major goals in healthcare. Srinagarind Hospital, Faculty of Medicine, Khon Kaen University is a pioneer in the integration of patient safety and risk management in
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the medical curriculum. In 2008 the Healthcare Accreditation Institute, Thailand, announced the Thai Patient Safety Goal using S I M P L E strategy which is Safe Surgery, Infection Control, Medication Safety, Patient Care Process, Line, Tube & Catheter, and Emergency Response respectively. The understanding of patient safety by using S I M P L E is very important for medical staff including medical students. Summary of work: Objectives: 1) to study the understanding 5th year medical students have in patient safety following the S I M P L E strategy and 2) to study the degree of implementation of patient safety strategy in real-life practice. Method: Descriptive study by using S I M P L E questionnaire.